静吸复合麻醉和全凭静脉麻醉在腹腔镜胆囊手术中的麻醉效果研究

Study on the anesthetic effect of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic gallbladder surgery

目的研究静吸复合麻醉和全凭静脉麻醉在腹腔镜胆囊手术中的麻醉效果。方法112例腹腔镜胆囊手术患者,以信封随机抽取法分为对照组和观察组,每组56例。对照组患者术中开展静吸复合麻醉,观察组患者术中开展全凭静脉麻醉。比较两组麻醉指标(麻醉拔管时间、苏醒时间、定向力恢复时间)、应激指标[去甲肾上腺素(NE)、皮质醇(Cor)]、生理指标[平均动脉压(MAP)、心率]、免疫指标(CD3+、CD4+、CD4+/CD8+)、炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)]、不良反应发生情况。结果观察组麻醉拔管时间、苏醒时间、定向力恢复时间分别为(6.25±0.62)、(5.67±0.13)、(9.19±1.05)min,显著短于对照组的(7.69±0.69)、(6.95±0.22)、(14.36±1.12)min,差异具有统计学意义(P<0.05)。术后,观察组NE、Cor水平分别为(7.47±0.35)、(216.88±3.30)nmol/L,均低于对照组的(9.72±0.59)、(356.13±3.25)nmol/L,差异具有统计学意义(P<0.05)。插管即刻(T1)、手术开始5 min(T2)、拔管即刻(T3)时,观察组心率、MAP均低于对照组,差异具有统计学意义(P<0.05)。术后,观察组CD3+、CD4+、CD4+/CD8+分别为(69.02±1.46)%、(43.79±0.16)%、(1.42±0.12),均高于对照组的(60.62±1.45)%、(39.68±0.18)%、(1.30±0.11),差异具有统计学意义(P<0.05)。术后,观察组hs-CRP、IL-8、IL-6水平分别为(12.74±3.22)mg/L、(22.25±0.22)pg/ml、(13.36±2.14)pg/ml,低于对照组的(19.65±3.24)mg/L、(35.56±0.25)pg/ml、(24.81±2.26)pg/ml,差异具有统计学意义(P<0.05)。观察组不良反应发生率为1.79%,低于对照组的12.50%,差异具有统计学意义(P<0.05)。结论全凭静脉麻醉在腹腔镜胆囊手术中具有积极的应用价值,可以有效提高麻醉效果,稳定患者血流动力学,降低应激反应、炎症反应,减少对免疫功能的影响,值得临床推广。

Objective To study the anesthetic effect of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic gallbladder surgery.Methods 112 patients with laparoscopic gallbladder surgery were divided into a control group and an observation group by envelope random selection method,with 56 cases in each group.Patients in the control group underwent combined intravenous and inhalation anesthesia during surgery,while patients in the observation group underwent total intravenous anesthesia during surgery.Both groups were compared in terms of anesthesia indexes(exhalation time,recovery time,orientation recovery time),stress indexes[norepinephrine(NE),cortisol(Cor)],physiological indexes[mean arterial pressure(MAP),heart rate],immune indexes(CD3+,CD4+,CD4+/CD8+),inflammatory factors[hypersensitive C-reactive protein(hs-CRP),interleukin-8(IL-8),interleukin-6(IL-6)],and occurrence of adverse reactions.Results The extubation time,recovery time and orientation recovery time in the observation group were(6.25±0.62),(5.67±0.13)and(9.19±1.05)min,which were significantly shorter than those of(7.69±0.69),(6.95±0.22)and(14.36±1.12)min in the control group,respectively.The difference was statistically significant(P<0.05).After surgery,the levels of NE and Cor in the observation group were(7.47±0.35)and(216.88±3.30)nmol/L,respectively,which were lower than those of(9.72±0.59)and(356.13±3.25)nmol/L in the control group,and the difference was statistically significant(P<0.05).Immediately after intubation(T1),5 min after beginning of surgery(T2),and immediately after extubation(T3),the heart rate and MAP of the observation group were lower than those of the control group,and the difference was statistically significant(P<0.05).After surgery,CD3+,CD4+and CD4+/CD8+in the observation group were(69.02±1.46)%,(43.79±0.16)%and(1.42±0.12),respectively,which were higher than those of(60.62±1.45)%,(39.68±0.18)%and(1.30±0.11)in the control group.The difference was statistically significant(P<0.05).After surgery,the levels of hs-CRP,IL-8 and IL-6 in the observation group were(12.74±3.22)mg/L,(22.25±0.22)pg/ml and(13.36±2.14)pg/ml,which were lower than those of(19.65±3.24)mg/L,(35.56±0.25)pg/ml and(24.81±2.26)pg/ml in the control group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 1.79%,which was lower than that of 12.50%in the control group,and the difference was statistically significant(P<0.05).Conclusion Total intravenous anesthesia has a positive application value in laparoscopic gallbladder surgery,which can effectively improve the anesthetic effect,stabilize the hemodynamics of patients,reduce the stress response and inflammatory response,and reduce the impact on immune function,which is worthy of clinical promotion.